1115 Application Process

Guidance for Former Foster Care Youth Section 1115 Demonstrations

On November 21, 2016, CMS announced a section 1115 opportunity to allow Medicaid coverage of former foster care youth  who have moved to a different state. To assist states in pursuing section 1115(a) demonstration authority to cover former foster care youth who currently reside in a different state than the state in which they were in foster care as of age 18 or when they “aged out” of foster care, CMS has developed two different guidance documents for states – one for states that provide Medicaid coverage under the new adult group and one for states that do not provide coverage under the new adult group. These guidance documents are structured so that states can be sure to include the necessary programmatic elements for providing coverage of former foster care youth under a section 1115 demonstration in alignment with federal transparency requirements.

• States That Provide Medicaid Coverage for New Adult Group
• States That Do Not Provide Medicaid Coverage for New Adult Group

Application Template for New Section 1115 Demonstrations

States have the option of using an interim template to develop their own applications. States are also encouraged to use the accompanying budget neutrality template in developing their applications. States may either download and complete the template, or simply use it as guide as they develop the application. States may submit completed applications to 1115demorequests@cms.hhs.gov.

Application Template for Extending Section 1115 Demonstrations – FAST TRACK REVIEWS

CMS established a new “fast track” process for reviewing proposals from states to extend established Medicaid and CHIP 1115 demonstrations that reauthorize longstanding policies with proven program outcomes.  States that want to be considered for the fast track process must use the streamlined extension application for the 1115 extension pathway it is requesting to be extended under.  

Click on the following links to download and complete the fillable application template for:

Section 1115(a) extensions

Section 1115(e) extensions

Section 1115(f) extensions

Fast Track Extension Template

States may submit completed applications to 1115demorequests@cms.hhs.gov.  For more information on the Fast Track review process, please review the CMCS Informational Bulletin released July 24, 2015.

Section 1937 of the Social Security Act as in effect in 2009 – This document provides the statutory language in effect as of December 1, 2009 and may be helpful to section 1115 demonstration states analyzing benefits provided to certain demonstration eligible as of that date.”  

Benchmark Standards in Effect on December 1, 2009

More About the State Section 1115 Application Process

Effective  April 27, 2012, in accordance with section 10201(i) of the Affordable Care Act that set forth transparency and public notice requirements for section 1115 demonstrations, states will need to include the following components in  demonstration applications in order for CMS to consider the application submission complete for the purpose of initiating federal review.

Initial 1115 submissions:

• A comprehensive program description of the demonstration, including the goals and objectives to be implemented under the demonstration project.
• A description of the proposed health care delivery system, eligibility requirements, benefit coverage and cost sharing (premiums, copayments, and deductibles) required of individuals who will be impacted by the demonstration to the extent such provisions would vary from the State’s current program features and the requirements of the Social Security Act.
• An estimate of the expected increase or decrease in annual enrollment, and in annual aggregate expenditures, including historic enrollment or budgetary data, if applicable.
• Current enrollment data, if applicable, and enrollment projections expected over the term of the demonstration for each category of beneficiary whose health care coverage is impacted by the demonstration.
• Other program features that the demonstration would modify in the State’s Medicaid program and/or Children's Health Insurance Program.
• The specific waiver and expenditure authorities that the State believes to be necessary to authorize the demonstration.
• The research hypotheses that are related to the demonstration’s proposed changes, goals, and objectives, a plan for testing the hypotheses in the context of an evaluation, and, if a quantitative evaluation design is feasible, the identification of appropriate evaluation indicators.
• Written documentation of the State’s compliance with the public notice requirements, with a report of the issues raised by the public during the comment period, which shall be no less than 30 days, and how the State considered those comments when developing the demonstration application.

Extensions of Existing Demonstrations:

• A historical narrative summary of the demonstration project, which includes the objectives set forth at the time the demonstration was approved, evidence of how these objectives have or have not been met, and the future goals of the program.
• If changes are requested, a narrative of the changes being requested along with the objective of the change and the desired outcomes.
• A list and programmatic description of the waivers and expenditure authorities that are being requested for the extension period, or a statement that the State is requesting the same waiver and expenditure authorities as those approved in the current demonstration
• Summaries of External Quality Review Organization (EQRO) reports, managed care organization (MCO) and State quality assurance monitoring, and any other documentation of the quality of and access to care provided under the demonstration.
• Financial data demonstrating the State’s historical and projected expenditures for the requested period of the extension, as well as cumulatively over the lifetime of the demonstration. This includes a financial analysis of changes to the demonstration requested by the State.
• An evaluation report of the demonstration, inclusive of evaluation activities and findings to date, plans for evaluation activities during the extension period, and if changes are requested, identification of research hypotheses related to the changes and an evaluation design for addressing the proposed revisions.
• Documentation of the State’s compliance with the public notice process, with report of the issues raised by the public during the comment period and how the State considered the comments when developing the demonstration application.

States should review the full content of section 42 CFR 431.412 of the CMS Final Rule to confirm that it has met all of the pre-submission application requirements outlined in this subpart. Please note that while the Final Rule left open the applicability of public notice requirements to proposed amendments, to ensure that the public is afforded the same degree of transparency and input on proposed amendment requests, CMS applies application "completeness" requirements to state applications for amendments as well as posts and accepts public comments on all amendments.

Final Rule-Review and Approval Process for Medicaid and CHIP Section 1115 Demonstrations